| Objective It is a real challenge to differentiate tuberculosis from malignancy in18F-FDG imaging, since extrapulmonary tuberculosis often show multiple feature. Through the retrospective analysis of18F-FDG PET/CT examination materials of90cases suspected or except not extrapulmonary tuberculosis, to analysis different types of extrapulmonary tuberculosis characteristics in PET/CT, to evaluate the diagnosis value of18F-FDG PET/CT on the extrapulmonary tuberculosis. In order to improve the diagnosis and differential diagnosis of the disease.Materials and Methods18F-FDG PET/CT was applied to90cases (46males,44females; mean age58.5±18.0y) suspected or except not extrapulmonary tuberculosis by common imaging examination (B ultrasonic, X-ray plain film, CT, MRI). Data of PET scan were reconstructed and fused with CT slices. All of the PET images were reviewed visually and semi-quantitatively with Standardized uptake value. Diagnosis of extrapulmonary tuberculosis was mainly based on lesion’s position, morphological characteristics on CT, tracer concentration features and lesion distribution on PET, and medical history of the patient, etc. PET/CT image of each patient was recorded in detail. Maximum standard uptake value (SUVmax) of the lesion was measured on the slices with the highest radiai activity. Final diagnosis of the patients were confirmed with clinical follow-up or histopathology or diagnostic treatment. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET/CT on different types of extrapulmonary tuberculosis computed at patient level, and SUVmax differences of different types of extrapulmonary tuberculosis, and/or benign lesion besides of tuberculosis, Malignant lesions were computed at lesion level.Results According to final diagnosis result and lesion’s position,90cases were divided into lymphadenopathy group, serous disease group, osseous group, intestinal group and other parts group.1.43cases were finally diagnosed with extrapulmonary tuberculosis, including27cases with tuberculous lymphadenitis (62.7%,27/43),23cases with serous tuberculosis (53.4%,23/43),16cases with osseous tuberculosis (37.2%,16/43),4 cases with tuberculosis of intestines (9.3%,4/43),2cases with liver tuberculosis (4.6%,2/43),1case with adrenal tuberculosis,1case with fallopian tube tuberculosis (2.3%respectively,1/43), in the43cases with extrapulmonary tuberculosis examined by PET/CT, there were209tuberculosis sites and SUVmax was8.82±4.1.8cases were finally diagnosed with Granuloma sex besides of tuberculosis, including7cases with sarcoidosis,1cases bone eosinophilic granuloma.39cases were finally diagnosed with malignant lesions.2. In lymphadenopathy group, lymph node tuberculosis manifested as single or multiple enlarged lymph node coalesced and calcification with significant FDG uptake, part of them are ring-like FDG-avidity. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET/CT on serous tuberculosis were85.18%(23/27),89.28%(25/28),87.27%(48/55) respectively. Lymph node tuberculosis SUVmax was7.4±3.2; sarcoidosis SUVmax was12.8±8.6; The lymphatic system malignant lesions SUVmax was9.9±7.3. Single factor analysis of variance show, the difference between the SUVmax values of lymph node tuberculosis and the lymphatic system malignant lesions, sarcoidosis and the lymphatic system malignant lesions was not of statistical significance.3. In serous disease group, pleural and peritoneal tuberculosis performance for heterogeneous or nodular in pleural/peritoneal thickening and and radio-tracer distribution. The sensitivity, specificity, accuracy of PET/CT on serous tuberculosis were82.60%(19/23),60.00%(6/10),75.75%(25/33) respectively. Serous tuberculosis SUVmax was9.5±4.8; Serous malignant sites SUVmax was10.6±7.0; The difference between the SUVmax values of serous tuberculosis and serous malignant sites was not of statistical significance.4. In osseous disease group, bone tuberculosis with osteolytic osseous destruction, paravertebral cold abscess, majority radio-agent ring-like intense uptake. The sensitivity, specificity, accuracy of PET/CT on bone tuberculosis were62.50%(10/16),85.71%(6/7),69.56%(16/23) respectively. Bone tuberculosis SUVmax was8.5±5.3; bone of malignant SUVmax was8.5±5.3; The difference between the SUVmax values of bone tuberculosis and bone of malignant was not of statistical significance.5. In intestinal group,4cases of intestines tuberculosis, all patients indicated ileocecus infiltration to circumferential or eccentric thickening, focal or diffuse high FDG activity. The sensitivity, specificity, accuracy of PET/CT on bone tuberculosis were75.00%(3/4),85.71%(6/7),81.81%(9/11) respectively. Intestines tuberculosis SUVmax was8.2.■1.8; bowel malignant sites SUVmax was16.1±3.4; The difference between the SUVmax values of intestines tuberculosis and bowel malignant sites was not of statistical significance.Conclusion F-FDG PET/CT has diagnosis value in extrapulmonary tuberculosis, osseous, lympho nodal tuberculosis indicate ring-like FDG intense and Multiple focal radio-active intense lesions, which were relatively lesse volume than that in CT imaging. Which are specific performance in PET/CT, different from Malignant lesions. SUVmax’s differentiation value to tuberculous, Granuloma sex besides of tuberculosis and Malignant lesion is limited, PET scan should fused with CT slices. When lesion’s performance still not typical, in order to improve veracity, it is necessary to combined with clinic materials, laboratory examinations and biopsy. |
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